Clark, Justin Charles
Clark, Justin Charles is an sole proprietor health care provider with primary practice located at 414 Plymouth Ne , Grand Rapids MI 49505-6041. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurological Surgery, which is considered as his primary health care specialty. Clark, Justin Charles can be contacted via phone (616) 454-3465.Contact Information
Primary practice address
414 Plymouth Ne
Grand Rapids MI 49505-6041
Phone: (616) 454-3465
Fax: (616) 242-7060
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurological Surgery | 207T00000X | 4301104141 | Michigan |
Profile Details
| NPI number | 1598945644 |
|---|---|
| LBN Legal business name | Clark, Justin Charles |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 6th, 2007 |
| Last updated | Jun 26th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598945644 | NPPES |
| Arizona | Other | 80762 | TRAINING PERMIT |
| Arizona | Other | 4301104141 | TRAINING PERMIT |
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